Readiness for Implementation of Lung Cancer Screening A National Survey of Veterans Affairs Pulmonologists
Readiness for Implementation of Lung Cancer Screening A National Survey of Veterans Affairs Pulmonologists
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DOI：
10.1513/annalsats.201604-294oc
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发表时间：
2016-10-01
影响因子：
8.3
通讯作者：
Wiener, Renda Soylemez
中科院分区：
文献类型：
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作者：
Tukey, Melissa H.;Clark, Jack A.;Wiener, Renda Soylemez
理论基础：为了减轻筛查的潜在危害，专业协会建议肺癌筛查以多学科项目进行，有能力提供全面的护理，从通过肺结节评估进行筛查到治疗筛查发现的癌症。目的：与政策建议中描述的理想情况相比，评估国家卫生保健系统中临床设施实施全面肺癌筛查计划的准备情况。方法：这是一项横断面、自填式调查，调查对象是退伍军人卫生行政机构肺部门诊的工作人员肺科医生。测量和主要结果：设施级应答率为84.1%(126个设有肺部诊所的机构中有106个)；88.7%的机构对肺癌筛查的证据表现出良好的提供者感知，73.6%的机构具有良好的提供者感知的本地筛查实施环境。政策建议的全面筛查计划基础设施的所有要素都存在于106个设施中的36个(34.0%)；最常见的缺陷是缺乏现场正电子发射断层扫描仪或放射肿瘤学服务。总体而言，26.5%的退伍军人健康管理局设施为实施肺癌筛查做好了理想准备(如果放弃现场正电子发射断层扫描和放射肿瘤学服务的政策建议，则44.1%)。结论：许多设施可能不适合实施全面的肺癌筛查计划。为了确保安全、有效的筛查，医院可能需要投入资源或与能够通过筛查发现的癌症的下游评估和治疗为筛查提供全面护理的设施进行协调。
Rationale: To mitigate the potential harms of screening, professional societies recommend that lung cancer screening be conducted in multidisciplinary programs with the capacity to provide comprehensive care, from screening through pulmonary nodule evaluation to treatment of screen-detected cancers. The degree to which this standard can be met at the national level is unknown.Objectives: To assess the readiness of clinical facilities in a national healthcare system for implementation of comprehensive lung cancer screening programs, as compared with the ideal described in policy recommendations.Methods: This was a cross-sectional, self-administered survey of staff pulmonologists in pulmonary outpatient clinics in Veterans Health Administration facilities.Measurements and Main Results: The facility-level response rate was 84.1% (106 of 126 facilities with pulmonary clinics); 88.7% of facilities showed favorable provider perceptions of the evidence for lung cancer screening, and 73.6% of facilities had a favorable provider-perceived local context for screening implementation. All elements of the policy recommended infrastructure for comprehensive screening programs were present in 36 of 106 facilities (34.0%); the most common deficiencies were the lack of on-site positron emission tomography scanners or radiation oncology services. Overall, 26.5% of Veterans Health Administration facilities were ideally prepared for lung cancer screening implementation (44.1% if the policy recommendations for on-site positron emission tomography scanners and radiation oncology services were waived).Conclusions: Many facilities may be less than ideally positioned for the implementation of comprehensive lung cancer screening programs. To ensure safe, effective screening, hospitals may need to invest resources or coordinate care with facilities that can offer comprehensive care for screening through downstream evaluation and treatment of screen-detected cancers.